Cost-Effectiveness Analysis of Defect Closure Techniques After Conventional Endoscopic Mucosal Resection for Large...

Resection of large colon polyps carries a risk of delayed bleeding. This study aimed to evaluate the cost-effectiveness of single- and dual-modality defect closure techniques following conventional hot snare endoscopic mucosal resection (EMR) of large colon polyps.

A decision-tree cost-effectiveness analysis was performed from a healthcare payer perspective modeling a 20 mm right-sided polyp removed via conventional (hot) EMR. Model inputs were derived from pooled data from 4817 patients. Closure techniques evaluated included through-the-scope clips (TTSC), through-the-scope suturing (TTSS), hemostatic agent (HA), and multimodal combinations.

TTSC was the most cost-effective strategy (total cost $3842; 17.17 quality-adjusted life-years). HA and multimodal strategies (TTSS + TTSC, TTSC + HA) offered marginally higher effectiveness but at greater cost (HA, $3,932; TTSS + TTSC, $4339.25; TTSC + HA, $4,447.76), resulting in less favorable cost-effectiveness. Sensitivity analyses suggested TTSC remained cost-effective up to a total clip cost of $544.86 and with technical success rates ≥ 67%.

TTSC provides favorable clinical and economic outcomes, with institutional costs and procedural expertise influencing optimal closure strategy selection.